A nurse is caring for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse implement to reduce the client’s ammonia levels?

Choice A reason: Restricting fluid intake does not reduce ammonia levels in hepatic encephalopathy. Fluid management addresses ascites or edema, but ammonia accumulates due to impaired liver metabolism of protein, making fluid restriction irrelevant to the goal of lowering ammonia in cirrhosis. Choice B reason: Administering furosemide treats ascites or edema in cirrhosis by promoting diuresis but does not directly reduce ammonia levels. Ammonia results from protein metabolism, requiring dietary restriction, not fluid loss, making this an ineffective intervention for encephalopathy. Choice C reason: Administering vitamin K corrects coagulopathy in cirrhosis by aiding clotting factor synthesis but has no effect on ammonia levels. Ammonia accumulates from protein breakdown, requiring protein restriction, making vitamin K irrelevant to managing encephalopathy’s neurological symptoms. Choice D reason: Limiting protein intake (20-40 g/day) reduces ammonia in hepatic encephalopathy, as the damaged liver cannot metabolize protein, leading to ammonia accumulation. This intervention minimizes ammonia production, alleviating neurological symptoms like confusion, making it the most effective strategy for this condition.